| |
112 E Dixie Ave, Leesburg, FL 34748-6350 | |
(352) 787-1956 | |
(352) 365-6690 |
Full Name | |
---|---|
Type | Facility |
Speciality | Eyewear Supplier |
Location | 112 E Dixie Ave, Leesburg, Florida |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1275600892 | NPI | - | NPPES |
008872400 | Medicaid | FL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (* (Not Available)) | Secondary |
332H00000X | Eyewear Supplier | (* (Not Available)) | Primary |
Mailing Address | Practice Location Address |
---|---|
112 E Dixie Ave, Leesburg, FL 34748-6350 Ph: (352) 787-1956 | 112 E Dixie Ave, Leesburg, FL 34748-6350 Ph: (352) 787-1956 |